Water Efficient Rebate Request Form

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Water Efficient Rebate Request Form
Please correct the field(s) marked in red below:

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1. Rebate Type 
 *
1. Rebate Type
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2. Account Number on your Utility Bill
Please Use Format xxxxxx-xxxxx (ex: 012345-67890)
You must enter the correct account number or your request will not be processed.
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3. Name on Account
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4. Applicant's First Name
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5. Applicant's Last Name
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6. Account Street Address
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7. Account Zip Code
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8. Is the mailing address the same as property address? If NO, you MUST fill out the following section.*
 *
8. Is the mailing address the same as property address? If NO, you MUST fill out the following section.*
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9. Mailing Address
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10. City
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11. State
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12. Zip Code
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13. Email
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14. Phone Number
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15. Alternate Phone #
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16. Account Type
 *
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